Introduction to Clinical Pharmacology Chapter 18- Central Nervous System Stimulants

1. Introduction to Clinical PharmacologyChapter 18-Central Nervous System Stimulants

2. CNS Stimulants: Action • Analeptics: • Increase depth of respirations • Caffeine: • Cardiac stimulation; dilation of coronary; peripheral blood vessels; constriction of cerebral blood vessels; skeletal muscle stimulation

3. CNS stimulants: Actions (cont’d) • Modafinil: • Exact mechanism of action is not known, but drug is thought to bind to dopamine thereby reducing number of episodes • Amphetamines (sympathomimetics): • Elevate blood pressure; wakefulness; increase or decrease-pulse rate; produce euphoric state • Anorexiants: Suppress appetite

4. CNS Stimulants: Uses • CNS stimulants-treatment: • *Attention deficit hyperactivity disorder • *drug-induced respiratory depression • postanesthesia respiratory depression without reduction of analgesia • narcolepsy • *sleep apnea • exogenous obesity • fatigue

5. CNS Stimulants: Adverse Reactions • Neuromuscular reactions: • Excessive CNS stimulation; headache; dizziness; apprehension; disorientation; hyperactivity • Other: • Nausea; vomiting; cough; dyspnea; urinary retention; tachycardia; palpitations; anorexia

6. CNS Stimulants: Contraindications • CNS stimulants contraindicated: • Inpatients with known hypersensitivity; convulsive disorders; ventilation mechanism disorders • Nurse should not administer CNS stimulants to patients with: • Cardiac problems; severe hypertension; hyperthyroidism • Amphetamines: • *Contraindicated in glaucoma • *Amphetamines and anorexiants should not be taken concurrently or within 14 days of antidepressant medications

7. CNS Stimulant: Interactions

8. Nursing Process: Assessment • Preadministration assessment: • Respiratory depression: • Initial assessments: Blood pressure, pulse, respiratory rate • Note: Depth of respirations; any pattern to respiratory rate • Review: Recent laboratory test results

9. Nursing Process: Assessment • Preadministration assessment (cont’d): • Attention deficit hyperactivity disorder: • Amphetamine prescribed: Weigh patient and take blood pressure; pulse; and respiratory rate • Child with ADHD: Observe for patterns of abnormal behavior • Record summary: Document/chart client’s behavior; provides comparison/future changes

10. Nursing Process: Assessment • Preadministration assessment (cont’d): • Obesity: • Anorexiant or amphetamine: • Used for outpatient use • Obtain and record: • Blood pressure; pulse; respiratory rate; weight- before therapy starts and at each outpatient visit

11. Nursing Process: Assessment • Ongoing assessment • Respiratory depression: • Take blood sample: For arterial blood gas analysis; determine effectiveness of analeptic • Observe: Adverse drug reaction; report occurrence immediately to PHCP

12. Nursing Process: Nursing Diagnosis and Planning • Disturbed sleep pattern; ineffective breathing pattern; imbalanced nutrition • Expected outcomes: • Depends on reason for administration • Optimal response to therapy • Support patientneeds: Manage adverse drug reactions • Understanding: Drug regimen

13. Nursing Process: Implementation • Promoting an optimal response to therapy: • Amphetamines: Used for short-term treatment of exogenous obesity • Long term use: Causes addiction and abuse

14. Nursing Process: Implementation • Monitoring and managing patientneeds: • Disturbed sleep patterns: • CNS stimulant therapy: Causes insomnia; administer early in the day • Avoid: Coffee, tea, cola drinks, chocolate • Vital signs: Checked every 6 to 8 hours • Adverse reactions: Amphetamine use may require discontinuation of drug

15. Nursing Process: Implementation • Monitoring and managing patient needs (cont’d): • Ineffective breathing pattern: • Use of analeptic drugs for respiratory stimulation: Enhances breathing pattern • Doxapram: Causes urinary retention; measure intake and output, notify PHCP if patientunable to void or bladder appears distended

16. Geriatrics • *Older adults are more sensitive to CNS stimulants and may exhibit anxiety, nervousness, insomnia, mental confusion

17. Nursing Process: Implementation • Monitoring and managing patient needs (cont’d): • Imbalanced nutrition: Less than bodily requirement • Adverse reactions: Use of CNS stimulants-child with ADHD decreases appetite • Long-term treatment: CNS stimulants-retards growth in children

18. Nursing Process: Implementation • Monitoring and managing patientneeds (cont’d): • Imbalanced nutrition (cont’d): • Monitor: Weight, growth patterns in children on long-term treatment with CNS drugs • Frequently check: Height, weight of child to monitor growth • PHCP may periodically interrupt therapy to monitor effectiveness of therapy

19. Nursing Process: Implementation • Educating the patientand family: • Therapeutic regimen, adverse drug reactions are explained to patientand family • Emphasize: Need to follow recommended dosage schedule • Develop a teaching plan

20. Nursing Process: Implementation • Educating the patient and family (cont’d): • Additional teaching points: • Attention deficit hyperactivity disorder • Administer drug in morning 30 to 45 minutes before breakfast and before lunch. • Monitor and record behavior of child

21. Nursing Process: Implementation • Educating the patient and family (cont’d): • Additional teaching points (cont’d): • Narcolepsy: • Record: Number of times per day periods of sleepiness occur • Amphetamines and anorexiants: • Avoid: coffee, tea, carbonated beverages containing caffeine

22. Nursing Process: Evaluation • Child’s behavior, school performance-improves • Weight loss is achieved • Respiratory depression: Reversed • Fewer episodes of inappropriate sleep patterns reported • Adverse reactions are identified, reported, and managed